How do I get my body to calm down?
March 8, 2009 12:12 PM   Subscribe

How do I begin to deal with what appears to be generalized anxiety disorder? I am wondering about experiences with anxiety medication... Help me fix my whacked out body!

In the last year, my stress has gone from just being stress to anxiety of varying magnitudes. I'm looking to deal with this, and I'm beginning to wonder if medication is the way I need to go. I need some advice from those who've taken medication for anxiety or know those who have.

This probably deserves a little back story. I'm youngish (roundabout college age), and my teenage years were spent in turmoil because of my family. It may be worth mentioning that one of my parents is severely mentally ill (read: craaazy). While logically I've dealt with a lot of what it meant to be a child amid that--and yes, been to therapy--I went from that stress, to the stress of college and living on my own, to the positive but nonetheless stressful event of meeting and marrying a wonderful guy.

I kind of feel like I haven't had emotional rest in a long time, if really ever. This has all added up to the point that I can't rest now that most things are going well and right. (And yes, I try to meditate, but to little to no avail.) It's very frustrating, indeed.

In the last six months to year, I have had issues with sleeping (going to sleep, but no problems once I'm asleep), having my mild skin disorder rev up a bit (it's stress-related), and have begun to exhibit physical signs of an anxiety disorder.

That's probably what is most annoying. My head is mostly clear and logical. I do not have many irrational thoughts, and those I do have I can usually talk myself though, like most people. It's just my body gets keyed up over everything now, it seems. I am in my final year, and on my way to classes, I begin to get jittery, for instance, and my stomach turns to knots. Sometimes in class, I feel myself shaking a little and sweatier than usual. On other occasions, I have been walking down the road, fine and dandy, and then suddenly I get all this muscle tension and this "heavy" emotional feeling. Out of nowhere. There is absolutely no reason for this. I am not mentally nervous about going to the classes, meeting people, etc. My body just behaves this way, as far as I can tell.

Clearly, though, it is anxiety, just because of the way it makes me feel; it's like stress 2.0. About the only time I'm not getting all keyed up is when I'm with friends or my partner. At least that's good! My body seems to go nuts when I'm out on my own, so maybe I've got strange emotional issues surrounding that, but I really don't know what they'd be. I'm pretty ballsy and confident, even despite my body's funniness, so the reactionary anxiety symptoms are really bizarre.

Given this, should I take medication (or possibly Kava?) to get me over the hump? I get the impression that my body just needs to be trained to relax a bit, to sit down and STFU, if you will, and then it'll be able to do that. I would go back to CBT, but I don't really know what I'd talk about week in, week out, and I don't have that money or time to blow, anyway.

I know you are not my doctor, but I ask here, because I feel doctors and psychiatrists are pretty shit at honestly and realistically expressing the side effects--both positive and negative--of taking certain meds. I'd also like to know which meds you or your loved ones have had good/bad experiences with, so I will have something to go in with if/when I do see my doctor. Also, see my GP or look for a psychiatrist? My insurance is crap, so I will pay either way probably.

A throw-away account:
posted by anonymous to Health & Fitness (24 answers total) 11 users marked this as a favorite
If you haven't already. get a basic blood panel to check for thyroid disorder, etc. first before you assume this is psychiatric in nature.
posted by availablelight at 12:26 PM on March 8, 2009

First, it seems as your post reads kind of manic, and has signs of some of the "all or nothing thinking" that cognitive therapy is supposed to alleviate.

Second, what illness does one of your parents have?---with some illnesses (such as depression and manic-depression) there is often a genetic component. This information may help a psychiatrist suggest an initial medication strategy.

I feel doctors and psychiatrists are pretty shit at honestly and realistically expressing the side effects--both positive and negative--of taking certain meds

How antidepressants, mood stabilizers, and their ilk work is still more art than science---and so it is with side effects. It can take a long time for you and your psychiatrist to find the most effective medicine having the least side effects. Good luck !
posted by Napoleonic Terrier at 12:30 PM on March 8, 2009

Medication, while helpful to get you through the rough, shaky spots it essentially is only masking the underlying problem of why you're jittery and basically imploding at the core. Apparently there are issues you need to deal with in a big way; your body is basically telling you what you need to be paying attention to - that there is fear somewhere trapped in your consciousness and this is reverberating as anxiety in various locations in the physical and mental bodies. Only you know what these issues are, and only you can make the decision to deal with them. But deal you will have to at some point, because eventually the *tappings* of the body and mind become louder and the symptoms greater and before you know it that dose you were taking a few months ago no longer work as well as so you have to take more. It just gets messy from that point.

What works - kava kava, Rescue Remedy, controlled breath work , TAT, prayer (yes, really) and valerian root. Talk therapy helps take the immediate pressure off the urgency of the issue, but from experience it is probably a wise move to get into some kind of cognitive therapy where you can change your primal instinctive reaction to a conscious response from choice.
posted by watercarrier at 12:38 PM on March 8, 2009 [1 favorite]

I have GAD too. I take Paxil, which helps a lot. Side effects for me were sleeping for almost three days straight when I first started it, and being groggy for another good week afterwards, but that eventually went away. If you drink any caffeine, cut it out. This significantly helped with the anxiety and feeling jittery. I was also part of a research study on how yoga effects the symptoms of adult onset GAD - and the yoga really does help!
posted by at 1:07 PM on March 8, 2009 [2 favorites]

I can only speak for my own experience with mood and anxiety badness, but this is what is (slowly) working for me:

When I feel a panic attack coming on (in your own example, when you begin to get jittery on your way to class), I take a short-acting benzo to get the anxiety and shakiness under control (it usually kicks in within a half-hour. While I'm waiting for it to kick in, I practice deep breathing exercises. It really, really does work to slowly train your body out of that jittery, overalert, depersonalized state - and give your mind a chance to rest.

For sleep: I'm trying to work on good sleep hygiene, like going to sleep at the same time each day, not napping and not drinking coffee after 2pm. I'm also on psychiatric meds that can be tuned to help me sleep better (if I get insomnia or start sleeping 14 hours a day, I'll talk to my psychiatrist about tuning the meds). Meditation is also good - keep at it!

I'd recommend going to a psychiatrist, not a GP, only because they have more experience in determining whether what you're having is generalized anxiety and how best to treat it.
posted by grippycat at 1:12 PM on March 8, 2009

Mindfulness. Keep working with your doctor, but also try the bodyscan and yoga techniques in Full Catastrophe Living.
posted by betweenthebars at 1:29 PM on March 8, 2009

A cobination of cognitive behavioural therapy and medication is usually the ticket. Medication (I'm on Celexa) helps take the edge off everyday living so that you can focus on working out your physical/emotional problems more calmly and clearheaded-ly. When I started on the Celexa I noticed that my hopelessness and dread, and my constant background anxiety kind of relaxed, and I've been making a point of taking at least half an hour every day to do some focused relaxation, like yoga or meditation or whatever. It's made a world of difference for me.

Also, check out the books by Martin M. Antony and/or Richard P. Swinson if you're a do-it-yourselfer.
posted by Dr. Send at 1:48 PM on March 8, 2009

I will second on the caffeine. I didn't drink very much of it, but I was experiencing the same "body anxiety" you seem to be describing.

While driving to work, I would have shoulders hunched, teeth clenched, muscles tensed, my whole body almost vibrating with stress, but I would feel perfectly happy mentally. I have a low stress job, not much traffic during my commute, which is short, etc.

About a week after giving up caffeine entirely, those symptoms were nearly 100% gone. I have a few random anxiety triggers and some stuff I stress about, but the body stuff is gone.
posted by peep at 2:36 PM on March 8, 2009 [1 favorite]

Try exercise and Omega-3 supplements. And cut down on Omega-6 (soy) sources in your diet. Omega-6 to Omega-3 ratio s/b ~1:1 instead of the ~20:1 or better that it probably is .
posted by torquemaniac at 2:56 PM on March 8, 2009

Best friend had the same symptoms. Here's how he fixed it.

Diet - no refined sugar, no corn syrup, cut all caffeine
Exercise (focused on cardio)
Low dosage of Xanax... used only during anxiety attacks. (be careful, very addictive)

He's a different person these days.
posted by Bighappyfunhouse at 3:14 PM on March 8, 2009 [2 favorites]

It's really frustrating, but please try to accept this: With mood drugs, there may be no way to predict how mild or intense your side effects will be, or even which side effects you'll experience. It's all trial and error, and it doesn't matter if your sibling or parent felt great or terrible with one type of pill, or if 90% of the population had a particular outcome: your experience could be the complete opposite. Your doctor (and you) make the best possible guess, and if a medication doesn't work or you can't tolerate the adverse affects, you switch to something else or you add another drug. Your physician can get you started, but once you've tried and rejected a few, you may need to see a psychiatrist. Psychiatrists don't much of anything for sure either, but they understand how unpredictable and varied the meds are for various patients. And they also know more about combining drugs to enhance the benefits or reduce side effects.

I've been helped enormously by antidepressants and antiaxiety drugs. The first one I tried was great... and then a few years later it stopped working. It then took several tries to find the right solution. There are many, many options. If at any point your doctor seems discouraged or suggests that you're "treatment resistant," move on to another doc. Hope is your greatest ally, and there is definitely reason for hope.
posted by wryly at 3:29 PM on March 8, 2009

Meditation may help. Exercise helps. Sunshine may help.

I had panic attacks on Prozac, and had better results with Zoloft. Individual experiences vary greatly.
posted by theora55 at 3:30 PM on March 8, 2009

First of all, self diagnosis, as we all have learned here at Metafilter, is particularly tricky/risky when it comes to emotional and psychiatric issues. From your description, I cannot tell if you are a little over stressed, or if you have a real primary anxiety disorder, a thyroid imbalance, bipolar disease, substance abuse, or schizophrenia. Don't put the cart before the horse, the medications used to treat these different possibilities have vastly different effects and it is not possible to tell you what to expect from meds without knowing which meds are likely to benefit you.

Second, if I am reading your question correctly, you are concerned about whether the medications that may be appropriate for you are worth the trouble. That's a pretty individual decision and depends primarily on how much your symptoms are impacting your life and what you are able to do on your own to cope. Yes, cutting back on alcohol/drugs/caffeine and increasing exercise or meditation will help, but it is frequently not enough if someone's symptoms have really spun out of control or if your work and home life prevent you from immediately starting to get the exercise, sleep, and relaxation time you need.

Medications for anxiety disorders (SSRIs and SNRIs) are generally pretty benign drugs. That's not to say that they don't have the potential for very uncomfortable side effects, but when that happens it is usually that they've been improperly dosed, and by going slow with incremental changes, I believe that *anyone* could safely and comfortably take one of these meds for an anxiety disorder. But since the therapeutic effect may take many weeks, and treatment usually goes for six months at a minimum, the decision to start a med is really a long term commitment to treatment.

Assuming you're not dealing with something really serious that mandates long term treatment like bipolar or PTSD (again, a big assumption), the role for meds is to quiet down a lot of those unconscious exaggerated reactions your body and brain are having to stressors while you learn to develop better stress management techniques, something that takes time. Do you think it's likely that if you just started going to the gym and meditating that you'd feel better in a few weeks? Then you might choose to hold off on meds. My experience is that most people already have some sense of their answer to this question.

Note that I'm not talking about benzodiazepenes like Valium and Xanax. These meds work, they work quickly and effectively and you may feel a lot better right away but they are not a long term strategy due to their addictive potential. These are primarily used at the beginning of treatment, if the person needs to be stabilized right away, and they should always be coupled with some other broader treatment plan.

It's too bad that you've found that doctors are pretty bad at discussing the side effects of medications they prescribe, that is part of their job. Sometimes it's difficult in the context of a 15 minute office visit. If you were to see a psychiatrist, there's a good chance they'd spend an hour with you at the initial visit and that might allow more time to get your questions answered. You might also be able to talk with your pharmacist in more detail about the med effects in particular.

For sort of run of the mill anxiety that is getting away from you, I always recommend The Wellness Book by Herbert Benson and Eileen Stuart. But really, if it is at all feasible, go see a doctor if you want to discuss medications more.
posted by Slarty Bartfast at 3:55 PM on March 8, 2009

Ps: SSRIs=Prozac, Zoloft, Paxil, etc. My favorites, due to their easy dosing and flat side effect profile are Celexa (which comes generic) and Lexapro.

SNRIs=Venlafaxine and Cymbalta, second line agents, imo.

Again, I have *no idea* if these are appropriate for you.
posted by Slarty Bartfast at 4:02 PM on March 8, 2009

I'm going to second (or third?) the Cognitive Behavioral Therapy + medication combo (with the diagnosis of a psychiatrist).
posted by Griffinlb at 4:33 PM on March 8, 2009

Note that I'm not talking about benzodiazepenes like Valium and Xanax. These meds work, they work quickly and effectively and you may feel a lot better right away but they are not a long term strategy due to their addictive potential.

They are a perfectly fine long-term strategy if you take them only intermittently. I take one or two 250 microgram Xanax maybe once, sometimes twice a week, sometimes none for up to two weeks. I am in no way addicted and it is very, very helpful for anxiety.

It beats the hell out of spending my life with my head between my knees trying to breathe, that's for sure.
posted by DarlingBri at 4:47 PM on March 8, 2009 [1 favorite]

It sounds like conscious, rational mind is trying really hard to keep unconscious, emotional forces under control. Of course, that's not a bad thing, and it's certainly feels safer to do this, but you're probably really needing to feel some of those raw feelings, and express them as much as possible. I know you said you're doing therapy, but sometime once a week isn't enough, in times when lots of issues are coming up fast and sending your body into havoc. Underlying trauma and old repressed feelings may be coming up, and it doesn't matter what triggered it.

Of course, meds may be necessary, but if you can get at some of these feelings, over time, you may feel much better on your own.
posted by Rocket26 at 4:55 PM on March 8, 2009

I have some form of generalized anxiety disorder, and experienced much the same in terms of irrational body-anxiety when my mind wasn't even a bit troubled. For two years I took a benzo (Ativan 0.5mg) whenever I felt my throat start to close and it kicked in after only a few minutes, if that. It fixed the short term problem.

However, I found that I needed to take it up to 4 times a day when under stress (at work or at school) and it was not really solving anything.

I *hate* SSRIs and SNRIs because I have had so many damn side effects from all of them I have taken (three so far). I am a medical professional, so I read up on the side effects on the web and in my books before I take anything. I suggest you do the same. A doctor or psych might not tell you every single side effect beforehand because every medication has a million of them. They are listed in that little typed up sheet you get from the pharmacy when you fill a script. They are different for everyone. Sometimes the rarest side effect is the one you feel. Sometimes you wouldn't have even noticed a side effect unless you actually read the prescribing information. YMMV.

Anyhoo. I am now on a beta-blocker. It just so happens that I have idiopathic (aka idiots don't know where it comes from) tachycardia (aka fast heart rate). Beta blockers lower my heart rate and reduce my sympathetic (fight or flight or freeze) nervous system's reaction to stimuli. Works *perfectly* for me. I still have the benzos, but I don't take them.
posted by nursegracer at 5:39 PM on March 8, 2009

Specifically, Bikram Yoga.
posted by GPF at 6:28 PM on March 8, 2009

I could have written this post. I've been anxious all my life, which I used to think was "just the way I was meant to be," because I come from a family of Woody-Allen-ish Jews. Like you, my anxiety hits me physically. I walk around (or used to walk around) with a little pain in my stomach pretty much all the time. The TINIEST thing could set it off -- like a neutral-voiced phone message from a friend saying, "Could you call me?" I'd assume it was "something bad" and the stomach knots would start. Insomnia was also a problem. It still is, for reasons I'll go into.

Last year (at the age of 42 -- WHY DID I WAIT SO LONG?) I got fed up with myself, went to the doctor, and told him I was tired of being a nervous wreck all the time. He prescribed Celexa to lower my level of general anxiety and Xanax for emergencies.

Xanax is habit forming, so you don't want to rely on it. I take it maybe once a month, if something really terrible happens (e.g. I get fired). It has no noticeable effect (no high, no euphoria, no negative effects) except that I cope with the emergency better. It's a great security blanket. Like I said, I rarely take it, but it calms me just to know it's in my pocket.

Celexa takes about three weeks to start working. You have to take it every day, and you CAN'T go off it cold turkey without horrible side effects. For the first month, I was on 10mg, and it didn't help at all. So my doctor upped me to 20mg. I can't stress strongly enough how important it is to find a doctor who will work with you. Everyone reacts to meds differently. It may take a while to get your dosage correct.

As with the Xanax, I don't notice much of a difference in my day-to-day life now that I'm on Celexa. I still think sharply. I'm not Mr. Happy. But I somehow don't get the stomach cramps all that often. For me, it's been awesome -- in a quiet way.

The negatives:

1. Celexa is making it HARDER for me to sleep. I am still working on this, trying taking it at different times during the day. My wife also takes Celexa, and her doctor has given her sleeping pills (Ambien) to help. I may go that route.

2. There have been some -- ahem -- sexual side effects, but nothing too extreme in my case. Managable.

3. I am finding it harder to get things done. I procrastinate more. I don't think this is a "side effect." I think it's the price I have to pay for being calmer. I learned to use anxiety to make me do stuff. It became a crutch. I just need to learn not to rely on it any more.

4. I still get anxious -- but like a normal person. In other words, if my boss fires me, I'm going to get upset. That's normal, but I sometimes get upset that I'm upset. I think, "I'm taking Celexa! It's supposed to make me not feel like this." I have to remind myself that it's not magic. If it made me never feel upset -- even when anyone would feel upset -- it would turn me into some kind of smiling idiot.

Good luck!
posted by grumblebee at 8:15 PM on March 8, 2009 [2 favorites]

I had symptons similar to yours, and my doctor diagnosed it as general anxiety disorder. He prescibed fluoxetine (or prozac) and, two months later, it's worked like a dream. I've not had any side-effects either, which may be just my luck.
posted by malpractice at 8:43 PM on March 8, 2009

Re anti-depressants - they can be HELL getting off once you start them. Absolute, 100%, certifiable HELL as many here can attest. Headaches, sleeplessness, restlessness and just symptom after symptom after symptom for MONTHS on end. Withdrawal of this magnitude may make you consider whether you want to go down that route. And if you do, to weigh the pros and cons of any pharmaceutical you take against its withdrawal effects should and when you decide to taper off.
posted by watercarrier at 4:24 AM on March 9, 2009

before you try any pharmaceutical I suggest magnesium supplements, specifically magnesium glycinate. taking 400MG (100MG, 4x per day) magnesium glycinate cured my stress related anxiety.

Good luck!
posted by Sagres at 1:26 PM on March 9, 2009

Be careful taking antidepressants since you have a "crazy" relative. I have several close relatives with manic depression, and was told by one psychiatrist not to take antidepressants as they might induce a manic or depressive episode. That psychiatrist put me on a very low dose of Clonapen. I was on Clonapen for two years for generalized anxiety and panic attacks, and had two slight dose increases over the two years. I also started going to yoga and meditation classes. At the end of two years, my baseline was pretty much normal. Then I moved and got stressed out again. I went to a new shrink who told me I was a drug addict for wanting Clonapen again although I hadn't used Clonapen for about 6 months. The only thing he would give me was an antidepressant, although I told him what my previous psychiatrist had said. I was on a very limited insurance plan, and couldn't switch doctors. I needed something, so I took the antidepressants. Long story short, I ended up having a manic episode.

So, be careful with antidepressants. If you can, shop around for a psychiatrist until you find one who will listen to you. Do lots of research on the options you are given. Also, there are a lot of calming activities you can do to complement the meds. Good luck!
posted by mandapanda at 1:33 PM on March 9, 2009

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